Nursing and Uterine Prolapse?

Hi Zubie

This comes up periodically. Postpartum women experience vaginal dryness that is somewhat like menopause, because of the lack of oestrogen in the body while the mother is not ovulating. We often read that pelvic organ prolapse often appears at menopause because the vaginal and vulval tissues atrophy. Yes, often women do report POP at that time but I suspect it has been there all along, but asymptomatic or not regarded as important enough to mention to the doctor.

This lack of ovulation is caused directly by the lactation in progress. As the baby weans, or lengthens out the time between feeds and amount of milk taken, oestrogen levels rise and the menstrual cycle begins again. This may be within a few weeks of birth if the mother is artificially feeding her baby, or a year or more if the baby is not eating a lot of other food and is visiting the breast frequently.

Some time ago I contacted the Australian Breastfeeding Association to ask them about the effect of weanng on POP. I was told that there is no clinical evidence that weaning will lead to an improvement in POP symptoms, presumably because the oestrogen levels are rising again well before weaning if weaning is gradual. The first oestrus is almost the last stage of oestrogen levels rising again.

However, your question was about weaning and ligaments/connective tissue, which is a bit different. Your body, its endopelvic fascia (which supports the pelvic organs) and your ligaments have been expanding for nine months, so it is going to take a long time to revert to pre-pregnant state, if in fact it ever reverts completely! Most Mums here find that at 12 months postpartum you have a good indication of how your body is reverting; some find two years is more likely. I found that my body stopped changing after my final pregnancy for 4 years or more, albeit at a very subtle level by then.

As far as I know the ligament loosening that happens during pregnancy is to allow your body to loosen up for the birth but they all tighten up again more quickly than the endopelvic fascia which has been grossly distended.

So it would appear that weaning doesn't really affect POP at all. It is related to time since giving birth, how the woman looks after her body postpartum, and what permanent damage remains from the birth. That is on top of the condition of the fascia and any asymptomatic POP from prior to the pregnancy and birth.

Vaginal childbirth is the most common factor in POP but it is by no means the only cause of POP, if it can be regarded as a 'cause' at all. Babies were always meant to come out through the vagina. If the birth process does not progress steadily and normally there is sometimes damage to the fascia and vaginal area during birth, or damage from surgical intervention which is done to keep the birth progressing, for better or worse.

So it really depends where you sit in all of this and how long since the birth of your baby. I suggest that you *don't even look* until 12 months postpartum, get your posture, your working environment, your diet, appropriate exercise, and your clothing organised to maximise your body's chances of reverting well and to prevent further damage from everyday activities. Learn to read your body by experiencing the sensations in the vulva and vagina and learn when to back off certain tasks; figure out other ways of getting them done, ie get someone else to do them or leave them until next year! In a couple of years time your body will be radically different from now and you should be able in the long term to return to normal activities as long as you listen to your body and adapt accordingly.

Cheers

Louise

Louise has given a brilliant answer! Just to say, that when I saw the surgeon he said they wouldn't see me again till 1 year PP, or longer if I was still breastfeeding--but breatsfeed as long as want to. When I saw the physio she said once my periods came back my hormones where pretty much normal, so quitting feeding wasn't really going to change anything, which it didn't. Interestingly though, what I did notice when I stopped feeding at about 2 years was that the pain from my symphesis pubis lessened quite a bit. So, something changed, but it wasn't my pops. They pretty much stabilised (to a much much better place!) by 2 years.

Interesting about the pubic symphysis. Perhaps the ligaments do remain relaxed for a longer time. I think there is a lot that we accept because it is common knowledge, so common that nobody challenges it if there is no good reason to challenge it.

Sounds like you are getting good advice.

L

I found it interesting too. Friend later told me her sister had sever SP (ie in a wheelchair) and again, stopping feeding resolved it. However, I know b/f counsellors told me the relaxin returns to normal just after birth so it's unaffected. I'm just glad no one told me ahead of time that it might make a difference, as I dwouldn't have wanted that in my head that maybe if i quit feeding I'd feel better...On the other hand, probably wouldn't have stopped me as it's short term my life for long term theirs, and it wasn't that bad....

duplicate post